Sense and non-sense of polypharmacy: increasing efficacy, decreasing compliance?

Abstract

The objective in managing patients with schizophrenia is to provide effective control of symptoms and enable the patient to reintegrate into society. Pharmacotherapy should, therefore, aim to provide optimum symptom control with minimal side effects using a simple dosage regimen. Ideally, this would be achieved through the use of a single agent. Some patients are successfully managed with a single antipsychotic drug, but it is often necessary or thought to be necessary to use a combination of agents to provide effective treatment. One European survey reported that most patients receive two to three psychotropic agents on average, but at least 5-22% receive five or more agents [53]. Unfortunately, the addition of more agents increases the risk of drug interactions, adverse events and non-compliance. This is amplified by the paucity of evidence-based medicine currently available to guide physicians in the use of combinations of agents, and the tendency of polypharmaceutical practice to be mostly driven by personal preference, clinical experience and marketing. This article therefore briefly looks at the feasibility of using various drug classes as adjunctive therapy in patients with schizophrenia.

Randomized controlled augmentation trials in clozapine-resistant schizophrenic patients: a critical review

“…During the last years several clozapine adjunctive agents have come into clinical practice to enhance the antipsychotic efficacy of clozapine [4,7,9,17,43]. Conventional or novel atypical antipsychotics [22,37], various antidepressants [6,39], lithium [40], novel anticonvulsants [44], dopamine agonists [1], glutamate receptor agonists [15], mazindol [8] and omega-3 fatty acids [31] have all been tried as clozapine adjuncts to address resistant positive, negative or cognitive symptoms.…”

Case Studies of Adjunctive Agents in Clozapine-Resistant Schizophrenic Patients

“…For most of them evidence is confounding and comes mainly from case studies or open-labeled trials, and randomized controlled trials are still sparse. [3][4][5][6][7] Although controlled trials of clozapine augmentation strategies have been published with an increasing frequency during the last few years, clinical practice still seems to be highly driven by case reports or case series, especially when it comes to deal with desperate difficult-to-treat cases.…”